Healthcare Provider Details

I. General information

NPI: 1457337362
Provider Name (Legal Business Name): RONALD RYO YAMADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 E YOSEMITE AVE STE 203
MANTECA CA
95336-5011
US

IV. Provider business mailing address

PO BOX 230
ORANGEVALE CA
95662-0230
US

V. Phone/Fax

Practice location:
  • Phone: 916-989-1887
  • Fax: 916-989-1887
Mailing address:
  • Phone: 916-989-1887
  • Fax: 916-989-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG30653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: